Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network
Authors: Quique Bassat, Dianna M. Blau, Ikechukwu Udo Ogbuanu, Solomon Samura, Erick Kaluma, Ima-Abasi Bassey, Samba Sow, Adama Mamby Keita, Milagritos D. Tapia, Ashka Mehta, Karen L. Kotloff, Afruna Rahman, Kazi Munisul Islam, Muntasir Alam, Shams El Arifeen, Emily S. Gurley, Vicky Baillie, Portia Mutevedzi, Sana Mahtab, Bukiwe Nana Thwala, Beth A. Tippett Barr, Dickens Onyango, Victor Akelo, Emily Rogena, Peter Onyango, Richard Omore, Inacio Mandomando, Sara Ajanovic, Rosauro Varo, Antonio Sitoe, Miquel Duran-Frigola, Nega Assefa, J. Anthony G. Scott, Lola Madrid, Tseyon Tesfaye, Yadeta Dessie, Zachary J. Madewell, Robert F. Breiman, Cynthia G. Whitney, Shabir A. Madhi, Ferdousi Begum, Mohammad Mosiur Rahman, Mohammed Kamal, A.S.M. Nawshad Uddin Ahmed, Mahbubul Hoque, Md. Atique Iqbal Chowdhury, Saria Tasnim, Mahbubur Rahman, Tahmina Shirin, Meerjady Sabrina Flora, Dilruba Ahmed, K. Zaman, Mohammed Sabbir Ahmed, Mohammed Zahid Hossain, Mustafizur Rahman, Shahana Parveen, Sanwarul Bari, Qazi Sadek-ur Rahman, Ferdousi Islam, Gutunduru Revathi, Aggrey K. Igunza, Magdalene Kuria, Paul K. Mitei, Florence Murila, Jennifer K. Verani, Mugah A. Christopher, Janet Agaya, Harun O. Owuor, Gregory O. Sadat, Joy Kuboka, Kephas Otieno, Richard Oliech, Peter O. Nyamthimba, Aluoch Anne, Peter O. Otieno, Dickson Gethi, Sammy Khagayi, Joyce Were Akinyi, Anne Ogollo, Thomas Misore, George Aol, David Obor, Maryanne Nyanjom, Mary Omwalo, Frederick Omondi, Were Zacchaeus Abaja, Doh Sanogo, Nana Kourouma, Seydou Sissoko, Uma U. Onwuchekwu, Diakaridia Sidibe, Tatiana Keita, Diakaridia Kone, Cheick Bougadari Traore, Jane Juma, Kounandji Diarra, Awa Traore, Tiéman Diarra, Kiranpreet Chawla, Sharon M. Tennant, Carol L. Greene, J. Kristie Johnson, Rima Koka, Karen D. Fairchild, Sandra Lako, Amara Jambai, Sartie Kenneh, Tom Sesay, Joseph Bangura, Babatunde Duduyemi, Princewill Phillip Nwajiobi, Foday Sessay, Martha Senessie, Chuka Oham, Ibrahim Bangura, Abdulai Othman Bah, Alim Swaray-Deen, Ronita Luke, Okokon Ita, Cornell Chukwuegbo, Sulaiman Sannoh, Julius Ojulong, Carrie-Jo Cain, James Bunn, Hailemariam Legesse, Francis Moses, James Squire, Oluseyi Balogun, Dickens Kowuor, Andrew Moseray, Khadija Gassama, Megan Bias, Rebecca P. Philipsborn, Tais Wilson, Navit T. Salzberg, Jeffrey P. Koplan, Josilene Nascimento Seixas, Jana M. Ritter, Margaret Basket, Sherif R. (deceased) Zaki, Ashutosh Wadhwa, Jacob Witherbee, Roosecelis Martines, Maureen Diaz, Jessica Waller, Jonas M. Winchell, Joseph O. Oundo, Fikremelekot Temesgen, Melisachew Mulatu Yeshi, Addisu Alemu, Alexander M. Ibrahim, Tadesse Gure, Stian Orlien, Dadi Marami, Yunus Edrids, Mahlet Abayneh Gizaw, Fentabil Getnet, Surafel Fentaw, Yasir Younis, Anteneh Belachew, Ayantu Mekonnen, Ephrem Lemma, Henok Wale, Yenework Acham, Celso Monjane, Sheila Nhachungue, Clara Menendez, Justina Bramugy, Milton Kincardett, Tacilta Nhampossa, Ariel Nhacolo, Khátia Munguambe, Pio Vitorino, Carla Carrilho, Fabiola Fernandes, Sozinho Acácio, Maria Maixenchs, Juan Carlos Hurtado, Jaume Ordi, Marta Valente, Natalia Rakislova, Dercio Chitsungo, Zara Manhique, Elisio Xerinda, Charfudin Sacoor, Yasmin Adam, Sanjay G. Lala, Karen L. Petersen, Peter J. Swart, Martin Hale, Jeannette Wadula, Jeanie du Toit, Fatima Solomon, Vuyelwa Baba, Hennie Lombaard, Nelesh Govendar, Amy Wise, Constance Ntuli
Journal: JAMA Network Open (2023)

Importance The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged &amp;amp;lt;5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival. Objective To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia. Design, Setting, and Participants The Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021. Main Outcomes and Measures The expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies. Results In this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions. Conclusions and Relevance In this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death.